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Opportunistic fungal infections in patients with neoplastic disease
Abstract:
Opportunistic infections with yeast and molds are increasingly common in patients with neoplastic diseases. Candida species, Aspergillus species, Phycomyces, and Cryptococcus neoformans remain most common, but other organisms are being encountered as pathogens. With the exception of Cryptococcus, most opportunistic fungal infections are difficult to diagnose. New diagnostic tests for these diseases are being evaluated. Amphotericin B remains the antifungal agent of choice. In certain patients, the addition of 5-fluorocytosine may improve the outcome. Experience with cryptococcosis in severely immunocompromised cancer patients at Memorial Sloan-Kettering Cancer Center suggests that those who are treated with amphotericin B intravenously and intraventricularly via an Ommaya reservoir along with 5-fluorocytosine do better than those treated with amphotericin B alone.
Insights
Opportunistic fungal infections are rising in cancer patients. Combination therapy with amphotericin B and 5-fluorocytosine shows improved outcomes for cryptococcosis in immunocompromised individuals.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Oncology
Background:
- Neoplastic diseases increase susceptibility to opportunistic fungal infections.
- Candida, Aspergillus, Phycomyces, and Cryptococcus neoformans are common pathogens.
- Diagnosis of most opportunistic fungal infections is challenging, except for Cryptococcus.
Purpose of the Study:
- To review the challenges and current approaches to diagnosing and treating opportunistic fungal infections in cancer patients.
- To evaluate the efficacy of antifungal agents, particularly in combination therapy for cryptococcosis.
Main Methods:
- Review of common and emerging fungal pathogens in immunocompromised patients.
- Discussion of diagnostic challenges and emerging diagnostic tests.
- Analysis of antifungal treatment strategies, focusing on Amphotericin B and 5-fluorocytosine.
Main Results:
- Amphotericin B is the primary antifungal treatment.
- Adding 5-fluorocytosine may enhance treatment outcomes in select cases.
- Combination therapy (Amphotericin B and 5-fluorocytosine) via intravenous and intraventricular routes improved outcomes for cryptococcosis in severely immunocompromised cancer patients.
Conclusions:
- Opportunistic fungal infections pose a significant threat to patients with neoplastic diseases.
- Effective diagnosis and treatment are crucial for improving patient prognosis.
- Combined therapy with Amphotericin B and 5-fluorocytosine offers a promising approach for managing severe cryptococcosis in immunocompromised cancer patients.